The Treatment of Subdural Collections in Patients With Shunted Normal Pressure Hydrocephalus: A Single-Center Experience.
Larger baseline subdural collection volume predicts failure of valve pressure adjustment alone.
The Treatment of Subdural Collections in Patients With Shunted Normal Pressure Hydrocephalus: A Single-Center Experience.
Normal pressure hydrocephalus (normal pressure hydrocephalus) affects approximately 0.2% to 2.9% of adults older than 65 years and is characterized by progressive gait impairment, cognitive decline, and urinary incontinence.
We aimed to characterize treatment strategies and outcomes for subdural collections in patients with shunted normal pressure hydrocephalus and to propose a practical management framework for nonemergent presentations.
We performed a retrospective cohort study of patients with shunted normal pressure hydrocephalus who developed subdural collections requiring treatment between January 2014 and September 2025.
AUROC; 1.0 is perfect, higher scores better predicted which collections needed more than valve adjustment
Sixty patients with 96 total collections underwent 91 valve pressure increases, 8 craniotomies for 8 collections, 23 middle meningeal artery embolization procedures for 32 collections, and 15 subdural evacuating port system procedures for 16 collections.
The median time to resolution for collections that underwent valve adjustment only, middle meningeal artery embolization without evacuation, evacuation without middle meningeal artery embolization, and both middle meningeal artery embolization and evacuation was 1.91, 3.99, 1.77, and 5.17 months, respectively.
Baseline hematoma volume may help identify which shunted normal pressure hydrocephalus patients with subdural hematomas are at higher risk of failing valve adjustment alone.
We propose a volume-informed management framework in which larger hematomas (approximately >40 cm3) prompt earlier consideration of treatment escalation.